Objective To investigate the clinical effect of soft-channel puncture drainage versus hematoma clearance via craniotomy and conservative medical treatment in the treatment of patients with moderate hypertensive intracerebral hemorrhage.Methods A retrospective analysis was performed for the clinical data of 114 patients with moderate hypertensive intracerebral hemorrhage who were admitted to our department from March 2016 to March 2019. According to the treatment method, they were divided into puncture group with 48 patients, craniotomy group with 34 patients, and conservative group with 32 patients. The three groups were compared in terms of the incidence rate of complications, long-term efficacy, average length of hospital stay.Results The puncture group had a significantly lower incidence rate of complications than the craniotomy group and the conservative group (P<0.05). The puncture group had a significantly better ADL classification at 3 months after onset than the craniotomy group and the conservative group. The puncture group had a significantly shorter mean length of hospital stay than the craniotomy group and the conservative group (20.3±2.2 d vs 26.4±3.5 d and 27.6±2.8 d, P<0.05).Conclusions Soft-channel puncture drainage has a better clinical effect than craniotomy and conservative treatment in the treatment of moderate hypertensive intracerebral hemorrhage, with good socioeconomic benefits, and therefore, it holds promise for clinical application in primary hospitals.